The 2003 Autumn Meeting was a quietly historic occasion in that it may be the last time that the BGS Autumn Meeting will be hosted in London.

As always, the Meetings Secretary and the Academic and Research Committee all played their part in producing a cracking scientific programme. Behind the scenes, the Hampton Medical Conferences team and the BGS staff, working with our new Chief Executive, ensured the smooth running of the usual business of feeding, watering and ushering 600 delegates around. Ninety posters were displayed and reviewed; and the various side shows of Special Interest Group AGMs, Trainees’ and NCCG meetings were smoothly accommodated and catered for.

Education, education, education
The business of educating would be doctors has been going on for decades - nay, centuries, but increasingly, the voices of senior educationalists with a particular interest in best educational practice are making their voices heard, and the mechanics of teaching medical undergraduates will become more formalised and call on even greater creativity and flexibility on the part of the educators. In recognition of this trend, the Wednesday session was dedicated to the subject of undergraduate medical education.

Prof Reg Jordan, Dean of Newcastle Medical School, spoke about the delivery of the “new” medical curricula using the North East as an exemplar. It is clear that a medical school, as well as dealing with the education agenda for doctors, has to take account of the inter-professional learning agenda of other health related disciplines.

Much of the medical schools’ education and training has moved out of the teaching hospital environment and is being conducted by `E-help’ i.e. virtual learning environment. Pivotal to students’ progress through the course are (a) assessment, (b) record keeping and (c) career guidance.

The next challenge according to Prof Jordan is how to blend and balance generalist versus specialist medical education.

Educating the educators

Educationalist psychobabble
The session finished with Dr Jonathan Robin from the Department of Clinical Pharmacology, University College London, talking to the subject of “Teaching Prescribing Skills to Medical Students and Junior Doctors”.

He began by saying that he didn’t have time for “educationalist psychobabble” and then went on to give us a splendid educationally sound lecture.

Good skills in pharmacology had to be developed early, was his premise. He went on to demonstrate the delivery of the UCL programme and its assessment. The course boasts plenty of novelty and is delivered by enthusiasts using up to date classroom methods and IT techniques. It was no surprise it was reported as the top scoring course in the UCL curriculum.

This was a splendid session and I am sure it would have had a very high evaluation by members of the audience if the BGS evaluated its sessions!

Accident and Emergency
Moving on from education, Hugo Dowd and Magnus Harrison from the North East, both A&E consultants, gave us a spirited dual presentation on pertinent topics to do with the older patient attending A&E Departments including TIA, stroke, syncope and falls, and hypothermia. It was a fast didactic evidence based delivery pointing to best practice and identifying the challenges in being in a position to deliver the most up-to-date intervention, for example, thrombolysis for stroke salvage.

Emphasis on systems modelling and resource allocation were to the fore, along with the enhancement and co-operation amongst departments, such as radiology and high dependency care.

The lexicon of axioms for lectures includes the principle of, “know your audience”. One felt that to some extent, it was a case of the speakers teaching their grandmothers to suck eggs.

The co-chair, Dr Sturgess, felt that in a session on emergency care, more emphasis could have been placed on the role that geriatricians play in systems modelling, to cope with the ever increasing number of older people being referred to our emergency services.

Coming to a home near you!
The session on new technologies began with Heinz Wolf (as seen on television!). Unusually he spoke for his allotted time without recourse to either Powerpoint or notes. He enjoys good health in his mid-70’s and it was encouraging to we younger ‘uns to witness the sharpness of his mind.

Prof Wolf’s subject was how technology can be beneficially applied to reduce the modern scourge of alienation and loneliness, particularly for older people.Technology can also help society cope with the emerging challenges of the demographic bulge, which the western world currently faces.

He then spoke of the Millennium project at Greenwich i.e. the “caring cottage”, where an 83 year old resident is served by a programmable system of telemetry, which helps to keep her secure. For example, it communicates a reminder if she forgets to lock her door at night, for example. Prof Wolf predicted that you might expect this technology to be coming soon, to a household near you!

Ken Doughty, a physicist by training, continued on this theme. He works in the Centre for Usable Home Technology at the Joseph Rowntree Foundation/York University. He described the available telecare products which can monitor client physiology and lifestye at home. His talk also illustrated how Telecare can restore independence by supporting discharge from hospital and indeed, monitoring parameters if an intermediate care intervention is working.
He illustrated his talk with real life examples of folk who currently benefit from programme monitoring which allows them to continue to live independently in their own homes, even if they have significant cognitive impairment.

Dr Timothy Kwok from Hong Kong described his experience of bed chair pressure sensory use in his patient group, resulting in a reduction in physical restraint. The session finished with Dr Frank Miskelly, senior lecturer from Imperial College and consultant geriatrician from Charing Cross, sharing his experience of a pilot scheme using electronic tagging and tracking in a care home setting.

He reminded us of how efficient the technology is and how quickly it is evolving, but like the other speakers in this session, his talk did not neglect the ethical issues of applying of such technologies.

Clinical Practice
Co-chaired by Juanita Pascual and myself, the session was devoted to leg ulceration; pressure sores; and nutritional supplementation and improved muscle function.

Prof Keith Harding from Cardiff gave us an erudite and amply illustrated lecture on the multi- factorial pathophysiology of lower limb ulceration. The presentation ranged from the basics at cellular level to the practicalities of management. He illustrated how the specialist can deliver high quality results, but how dependent he/she is on a team approach to problem solving. He went further, to demonstrate how basic research can be translated into clinical practice.

Qualitative Research
Research Nurse, Claire Wedge, presented a paper from Liverpool on older patients’ perceptions of decubitus ulceration. This was of particular interest as it used a qualitative method of action research for its methodology. Findings from the study were illustrated with narrative of patient experience, the power of which can be lost in using purely quantitative methods of research.

Rosemary Paice, Research Dietitian from Dundee, then presented a randomised control trial which provided evidence that nutrition and supplementation prescribed on hospital discharge results in improved muscle strength in older patients. It will be interesting to see if this evidence is translated into emerging clinical practice such as falls prevention strategies, where logic suggests it may help.

Awards

Dr Tricia Moylan receives the Ferguson Anderson Prize	Chandi Vellodi - retired Hon Secretary	Lord Stewart Sutherland receives the President's Medal

Kevin Kelleher